TDC First application

Small business rate relief form

Page 1

Reference number

Name of limited company / proprietor

Address

Billing address of small business making the application

Please enter your postcode in the box below, including the space, ie RH8 0BT, and click the 'Show Postcode Addresses' button and select your address.

Postcode

Address

E-mail address

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Telephone

Please enter the date from which you want the relief to begin

Please enter the end date of the relief if you only wish to claim for a limited period

Are you applying for the first time or are you notifying a change of circumstances in respect of small business rate relief

First applicationChange of circumstances

Page 2

First application

If the application is the first application in the valuation period in respect of a rateable assessment give the full address of the assessment for which business rate relief is sought

Please enter the property reference number (if known)

Please enter your billing number (if known)

Please enter the full address of any other property in England that the ratepayer occupies. If none please enter "NONE"

Enter the property reference number (if known)

Change of circumstances

If the application is being made to notify the billing authority of a change in circumstances but the assessment for which the ratepayer is seeking relief remains unchanged, state the assessment in England which the ratepayer has started to occupy since making their first application for the valuation period.

State the date on which the ratepayer started to occupy that assessment

Declaration

It is a criminal offence for a ratepayer to give false information when making an application for Small Business Rate Relief.

I confirm that the changes listed above are the only changes relating to the rateable assessment(s) in England occupied by the small business applying for this relief, and the date of those changes has been accurately stated.

I confirm that I have read and understood the declaration above

Yes

Name of ratepayer / person authorised to complete the application

Capacity of authorised person

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